A demographic study of acute megakaryoblastic leukemia using the national cancer database.
Authors: Eric Juang, Nikhil Furtado, Darby Keirns, Xinxin Wu, Peter T. Silberstein, Beau Hsia
Journal: Journal of Clinical Oncology (2023)

e19023 Background: Acute megakaryoblastic leukemia (AMKL) is a rare subtype of acute myeloid leukemia that, based on past studies, primarily affects children. Patients with Down syndrome (DS) have a higher risk of developing AMKL. While DS-associated AMKL has an overall survival rate of 80%, the prognosis of adult AMKL is much poorer (overall survival rate of &lt; 40%). The prognostic heterogeneity of AMKL warrants an investigation of its diagnostic trends in order to gain epidemiological insights. In this study, demographic data of AMKL patients was obtained from the National Cancer Database (NCDB) and analyzed to determine factors that affect the outcome of AMKL patients. Methods: In this retrospective cohort study, data from the 2004-2020 NCDB was analyzed to identify cases of AMKL with ICD-O-3 code 9910. Demographic data attached to the identified cases assessed included age, sex, race, Hispanic status, insurance status, facility type, surgery status, palliative care status, and Charlson-Deyo score. Descriptive statistics were obtained, and the incidence trends of AMKL were interpreted using regression analysis. Results: A total of 765 patients diagnosed with AMKL were identified in the database between 2004 – 2020 with a decreasing incidence of patients diagnosed per year (64 cases in 2004 and 11 cases in 2020; R^2 = 0.86). The average age of diagnosis was 40.3 years (SD = 32.4, range = 0 – 90 years, median = 51 years). AMKL exhibits slight male prevalence (55.2% vs 44.8% for females). The majority of the patients were Non-Hispanic White (77.6%). Most individuals had Charlson-Deyo comorbidity scores of 0 (79.1%). The incidence rates were similar across household income quartiles. 72.8% of AMKL cases were diagnosed in urban areas with a population of &gt; 250,000. Fewer cases were treated at community cancer programs as compared to either academic/research programs (45.1%) or integrated network cancer programs (20.6%). Private insurance (38.6%), Medicare (30.6%), and Medicaid (22.0%) were the most common insurance types. All patients received surgical intervention of the bone marrow and 3.2% of patients received palliative care. Conclusions: This NCDB-based demographic analysis on AMKL serves to improve the general understanding of AMKL. Surprisingly, the average and median ages of diagnosis are 40.3 and 51 years, respectively, which contradicts prior reports of AMKL being primarily a pediatric disease. Our analysis of the socioeconomic factors of AMKL patients showed that most AMKL patients were non-Hispanic Whites and diagnosed and treated in urban settings. In addition, the majority of AMKL patients had government insurance (54.6%; Medicare, Medicaid, and others). While this study provides initial insight into the role demographics play in the diagnosis and treatment of AMKL patients, further studies on how these factors contribute to their outcome would provide great value in understanding the social disparity in AMKL.